Dataset Information

Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study.

ABSTRACT: Antibiotics are over-prescribed in low-and-middle-income countries, where the infection rate is high. The global paucity of standard treatment guidelines and reliable diagnose-specific prescription data from high-infection risk departments such as the otorhinolaryngology (ENT: ears, nose and throat) is a barrier to rationalize antibiotic use and combat antibiotic resistance. The study was conducted to present diagnose-specific antibiotic prescribing patterns of five years at ENT inpatient departments of two private-sector Indian hospitals. Data of all consecutive inpatients (n = 3527) were collected but analyzed for the inpatients aged >15 years (n = 2909) using the World Health Organization's methodologies. Patient records were divided into four diagnoses groups: surgical, non-surgical, chronic suppurative otitis media (CSOM), and others. Of 2909 inpatients, 51% had surgical diagnoses. An average of 83% of patients in the clean surgery group and more than 75% in the viral and non-infectious groups were prescribed antibiotics. CSOM was the most common diagnosis (31%), where 90% of inpatients were prescribed antibiotics. Overall, third-generation cephalosporins and fluoroquinolones were most commonly prescribed. This study highlights the inappropriate prescribing of antibiotics to patients of clean surgeries, viral infections, and non-infectious groups. The single-prophylactic dose of antibiotic for clean-contaminated surgeries was replaced by the prolonged empirical prescribing. The use of microbiology investigations was insignificant.

SUBMITTER: Silfwerbrand E

PROVIDER: S-EPMC6862163 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study.

Silfwerbrand Elisabeth E Verma Sumeer S Sjökvist Cora C Stålsby Lundborg Cecilia C Sharma Megha M

International journal of environmental research and public health 20191023 21

Antibiotics are over-prescribed in low-and-middle-income countries, where the infection rate is high. The global paucity of standard treatment guidelines and reliable diagnose-specific prescription data from high-infection risk departments such as the otorhinolaryngology (ENT: ears, nose and throat) is a barrier to rationalize antibiotic use and combat antibiotic resistance. The study was conducted to present diagnose-specific antibiotic prescribing patterns of five years at ENT inpatient depart ...[more]

PMID: 31652748

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Project description:BackgroundFrequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients.AimTo compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India.MethodsData from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups.ResultsThird generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02).ConclusionSubstantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.

Project description:Background: Prompt and effective malaria diagnosis and treatment is a cornerstone of malaria control. Case management guidelines recommend confirmatory testing of suspected malaria cases, then prescription of specific drugs for uncomplicated malaria and for severe malaria. This study aims to describe case management practices for children aged 1-59?months seeking treatment with current or recent fever from public and private, rural and urban health providers in Mali.Methods: Data were collected at sites in Sikasso Region and Bamako. Health workers recorded key information from the consultation including malaria diagnostic testing and result, their final diagnosis, and all drugs prescribed. Children with signs of severe diseases were ineligible. Consultations were not independently observed. Appropriate case management was defined as both 1) tested for malaria using rapid diagnostic test or microscopy, and 2) receiving artemisinin combination therapy (ACT) and no other antimalarials if test-positive, or receiving no antimalarials if test-negative.Results: Of 1602 participating children, 23.7% were appropriately managed, ranging from 5.3% at public rural facilities to 48.4% at community health worker sites. The most common reason for 'inappropriate' management was lack of malaria diagnostic testing (50.4% of children). Among children with confirmed malaria, 50.8% received a non-ACT antimalarial (commonly artesunate injection or artemether), either alone or in combination with ACT. Of 215 test-negative children, 44.2% received an antimalarial drug, most commonly ACT. Prescription of multiple drugs was common: 21.7% of all children received more than one type of antimalarial, while 51.9% received an antibiotic and antimalarial. Inappropriate case management increased in children with increasing axillary temperatures and those seeking care over weekends.Conclusions: Multiple limitations in management of febrile children under five were identified, including inconsistent use of confirmatory testing and apparent use of severe malaria drugs for uncomplicated malaria. While we cannot confirm the reasons for these shortcomings, there is a need to address the high use of non-ACT antimalarials in this context; to minimize potential for drug resistance, reduce unnecessary expense, and preserve life-saving treatment for severe malaria cases. These findings highlight the challenge of managing febrile illness in young children in a high transmission setting.

Project description:OBJECTIVE:Despite provision of accreditation of private sector health providers in government-led schemes for maternity services in India, their participation has been low. This has led to an underutilisation of their presence, resources and expertise for providing quality maternal and newborn health services. This study explores the perception of various stakeholders on expectations, benefits, barriers and facilitators to private sector participation in government-led schemes-specifically Janani Suraksha Yojana (JSY)-for maternity service delivery. DESIGN:Narrative-based qualitative study. Face-to-face in-depth interviews were conducted with study participants. The interviews were transcribed, translated and analysed using a reflexive and inductive approach to allow codes, categories and themes to emerge from within the data. SETTING:Private obstetricians, government health officials and FOGSI (Federation of Obstetrics and Gynaecological Societies of India) members, Jharkhand and Uttar Pradesh, India. PARTICIPANTS:Eighteen purposefully selected private obstetricians from 9 cities across states of Uttar Pradesh and Jharkhand, 11 government health officials and 2 FOGSI members. RESULTS:The major factors serving as barriers to participation of private practitioners in JSY-which emerged on thematic analysis-were low reimbursement amounts, delayed reimbursements, process of interaction with the government and administrative issues, previous experiences and trust deficit, lack of clarity on the accreditation process and patient-level barriers. On the other hand, factors which were facilitators to participation of private practitioners were ease of process, better communication, branding, motivation of increasing clientele as well as satisfaction of doing social service. CONCLUSION:Factors such as financial processes and administrative delays, mistrust between the stakeholders, ambiguity in processes, lack of transparency and lack of ease in the process of empanelment of private sector are hindering effective public-private partnerships under JSY. Simplifying and strengthening the processes, communication strategies and branding can help revitalise it.

Project description:ObjectivesTo present and compare antibiotic prescribing for inpatients among the most common non-bacterial diagnoses groups at medicine departments of a teaching (TH) and a non-teaching hospital (NTH) in central India.SettingAn observational cross-sectional study was conducted at two tertiary care settings in Ujjain district, Madhya Pradesh, India.Data and participantsThe data were collected manually, using a customised form. Complete records of all inpatients, who were >15?years of age and had stayed for at least one night in either of the hospitals during 2008-2011, were analysed.Outcome measuresInpatients were grouped according to the presence or absence of a bacterial infectious diagnosis, viral/malaria fever or cardiovascular disease. Classes of antibiotics prescribed to these groups and adherence to the available prescribing guidelines were compared between the hospitals using the notes from the patient files and the diagnoses.ResultsOf 20?303 inpatients included in the study, 66% were prescribed antibiotics. Trade name prescribing and use of broad-spectrum antibiotics were more frequent at the NTH than at the TH (p<0.001). At the TH a significantly higher proportion of patients having fever without registered bacterial infection were prescribed antibiotics (82%) compared with the NTH (71%, p<0.001). Patients admitted for cardiovascular diagnosis without registered bacterial infections received antibiotic prescriptions at both hospitals (NTH 47% and TH 37%) but this was significantly higher at the NTH (p<0.001). None of the diagnoses were confirmed by microbiology reports.ConclusionsPrescribing antibiotics, including broad-spectrum antibiotics, to inpatients without bacterial infections-that is, viral fever, malaria and cardiovascular disease, was common at both hospitals, which increases the risk for development of bacterial resistance, a global public health threat. In view of the overprescribing of antibiotics, the main recommendations are development and implementation of local prescription guidelines, encouragement to use laboratory facilities and prescription analysis, with antibiotic stewardship programmes.

Project description:BackgroundRecreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children's access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them.MethodsWe used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools.ResultsThe keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers' nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY.ConclusionsANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods.

Project description:BACKGROUND: In 2009, the Global Fund to Fight AIDS, Tuberculosis and Malaria established the Affordable Medicines Facility-malaria (AMFm) in order to increase access to quality-assured artemisinin combination therapy (QAACT). AMFm Phase 1, which includes nine pilot programmes in eight countries, was launched in 2009. The objective of this study was to assess anti-malarial stock and purchase patterns at private outlets in five AMFm Phase 1 countries in regard to three of the core AMFm goals: increase the affordability of QAACT, increase the availability of QAACT, and crowd out artemisinin monotherapies and other substandard therapies. METHODS: The study was conducted between April and May 2012 and included interviews with personnel in 598 private pharmaceutical outlets in Ghana, Kenya, Nigeria, Tanzania, and Uganda. Questionnaires were administered at private retail outlets and the data were analyzed to assess within- and between-country differences in QAACT price, availability, and popularity. RESULTS: AMFm medications were less expensive than their non-AMFm counterparts, yet prices for both types were above country-specific suggested retail prices. Market penetration of AMFm QAACT in both urban and rural areas was high, although stock-outs of both AMFm and non-AMFm products were more common in rural compared with urban outlets in Ghana and Kenya (p = 0.0013). Government recommendation was the most significant factor influencing anti-malarial stock choices in urban (41.5%) and rural (31.9%) outlets. The three top-selling anti-malarials reported for both urban and rural areas in each country were, with the exception of rural Uganda and urban Nigeria, combination therapies. CONCLUSIONS: Results from this study indicate that the AMFm has not fully achieved its affordability and crowd-out objectives. Still, the final purchase price of AMFm QAACT was substantially lower than non-AMFm equivalents. Moreover, for both urban and rural areas, AMFm QAACT availability was found to be high, and the various forms of QAACT were the best-selling products among all anti-malarials. These findings suggest a continued need for initiatives like the AMFm that improve the affordability and accessibility of QAACT. Similar programmes may be especially effective if employed in combination with rapid diagnostic testing to ensure the appropriate use of these products.

Project description:The private healthcare sector in low- and middle-income countries is increasingly seen as of public health importance, with widespread interest in improving private provider engagement. However, there is relatively little literature providing an in-depth understanding of the operation of private providers. We conducted a mixed methods analysis of the nature of competition faced by private delivery providers in Uttar Pradesh, India, where maternal mortality remains very high. We mapped health facilities in five contrasting districts, surveyed private facilities providing deliveries and conducted in-depth interviews with facility staff, allied providers (e.g. ambulance drivers, pathology laboratories) and other key informants. Over 3800 private facilities were mapped, of which 8% reported providing deliveries, mostly clustered in cities and larger towns. 89% of delivery facilities provided C-sections, but over half were not registered. Facilities were generally small, and the majority were independently owned, mostly by medical doctors and, to a lesser extent, AYUSH (non-biomedical) providers and others without formal qualifications. Recent growth in facility numbers had led to intense competition, particularly among mid-level facilities where customers were more price sensitive. In all facilities, nearly all payment was out-of-pocket, with very low-insurance coverage. Non-price competition was a key feature of the market and included location (preferably on highways or close to government facilities), medical infrastructure, hotel features, staff qualifications and reputation, and marketing. There was heavy reliance on visiting consultants such as obstetricians, surgeons and anaesthetists, and payment of hefty commission payments to agents who brought clients to the facility, for both new patients and those transferring from public facilities. Building on these insights, strategies for private sector engagement could include a foundation of universal facility registration, adaptation of accreditation schemes to lower-level facilities, improved third-party payment mechanisms and strategic purchasing, and enhanced patient information on facility availability, costs and quality.

Dataset Information

Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study.

Publications

Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study.

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